Osteoporosis Flashcards
Define osteoporosis. (1)
Progressive systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissues with consequential increase in bone fragility and risk of fractures.
What are the risk factors of OP?
Smoking
Sedentary
Low BMI
Low Vitamin D
Coeliac disease
RA
IBD
Drugs
Early menopause
Steroids
Hyperparathyroidism
Hypogonadism
Family Hx OP
Parent Hip #
Alcohol
Falls
Sex
Age
What are the T-scores for OP?
-2.5 or less
Explain the use FRAX/QFRACTURE tools.
FRAX: Used whether to start tx, offer lifestyle advice or DXA referral. Low risk: lifestyle advice, intermediate risk: measure BMD, high risk: tx, very high risk: specialist referral and tx.
What are the lifestyle advice for OP? (5)
Exercise particularly weight-bearing exercise.
Adequate dietary calcium intake.
Vitamin D
Smoking cessation
Alcohol within recommended limits.
What are the treatment options for OP?
1st line: Alendronic Acid
2nd line: Risedronate
+/- calcium/vitamin D
Romosozumab
Teriparatide
Abaloparatide
Should px be Rx calcium and vitamin D tablets?
+/- of tx prior to starting.
Calcium generally less well tolerated than vitamin D component.
State how Alendronic acid is administered. (1)
First thing in the morning on empty stomach with full glass of water; wait half and hour other medicines, breakfast, cups of tea etc. Don’t lie back down for at least 30 mins.
Calcium taken at least 2-4 hrs after or omit on day of Alendronate.
State how Risedronate is administered. (1)
35mg once weekly.
Administered the same as Alendronic acid.
State how Ibandronic acid is administered. (1)
150mg oral once monthly. 3 mg IV 3 monthly.
Oral - as for Alendronic acid but longer duration for admin requirements (1hr) IV bolus over 15-30 sec.
State how Zolendronic acid is administered. (1)
5mg IV annual
IV infusion over 15 mins
State how Deosumab is administered. (1)
60mg SC 6 monthly
SC injection
What intervention is considered if a fracture has occurred after changes to tx? (4)
Check adherence, administration and adverse effects.
What are the short-term s.e of Zolendronic acid? (3)
Flu like symptoms (prophylactic paracetamol)
Hypocalcaemia (blood tests to check calcium and vitamin D before infusion. Vitamin D helps calcium absorption)
Renal impairment (blood tests to check kidney function is okay before starting, drink plenty of water.)
What are the long-term s.e of Zolendronic acid? (3)
Osteonecrosis of Jaw (Good dental hygiene, regular dental check ups. Any dental work prior if possible. Reminder card given.)
Atypical Fracture. (Report any unexplained hip, thigh or groin pain. X-ray to rule out.)
Osteonecrosis of auditory canal. (Report any ear pain/discharge or an ear infection during BP tx.)
What is the monitoring requirement of Bisphosphonates? (5)
Reviewed over 5 years due to high risk of atypical #.
Drug holiday = stop Bisphosphonate, usually 1-3 yrs.
Often used in practice with Bisphosphonate medications = long half-life. Sustained effect on cessation.
Continue beyond 5 yrs in very high fracture risk.
Advise that tx will be reviewed after 3 years.
What is the safety use of Denosumab? (2)
Drug holidays = not appropriate.
Increased vertebral # risk on discontinuation.
Explain the process of taking a Drug Hx in OP. (8)
Some preparation given in hospital or via home care.
What day of the week/month? Or when was last injection/due?
Teriparatide kept in fridge.
Romosozumab fridge but stable at room temperature.
Check adherence (poor?)
Check administration technique and calcium/medicines timing.
Px on a drug holiday (recently stopped medications. Have they ever taken a medication for bones?)
How long have they been taking it? (Reviewed after 5 yrs, 3 yrs =Zol, consider drug holiday 1-2 yrs or continue 7-10 yrs.)
Explain the process of clinical review in OP. (12)
What is the # risk? Is bone protection indicated? Rx/advise
Adherence?
Has the px # on tx?
Blood tests: changes to renal function, calcium status. (<35ml/min = Alendronate, < 30ml/min = Risedronate. Hypocalcaemia)
Consider calcium/vitamin D supplements (Omit if calcium dietary intake adequate (>700mg)
Parenteral treatment: Calcium, vitamin D, kidney function checked before each injection, correct hypocalcaemia, Vitamin D loading + maintenance if Vitamin D low.
Drug interactions: medicine timings.
S/E
Pain control? E.g. vertebrae #.
Falls risk/polypharmacy: medication review
Tx duration: review, drug holiday
C/I: Dysphagia, can’t follow administration requirement, women of childbearing potential.
ADR: Recognition, tx review, yellow card.
Invasive dental procedures: dental tx before starting to reduce ONJ risk, possible to go ahead on tx.
What is the implication of renal impairment in OP? (1)
High risk of hypocalcaemia if eGFR = < 30ml/min = monitor plasma calcium concentration.
What do you need to consider before commencing on Zolendronic acid?
Calcium/vitamin D/ renal function levels prior to tx.
